Has your license been restricted or suspended within the last 3 years?*

Yes

No

If yes, when?

Explain

Position(s) applied for:*

Status Applied for:*

Full-time

Part-time

Shift applied for:*

Day

Evening

Overnight

Number of hours available to work per week?*

Days requested?

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Have you ever applied at the ERM before?*

Yes

No

If yes, when?

When are you availalbe to begin work?*

What is your desired starting salary?*

Minimum acceptable salary?*

Are you able to perform the job functions for which you are applying?*

Yes

No

Explain:

How were you made aware of this position?*

Staff Referral

Advertisement

Job Fair

College

Word of Mouth

Walk-IN

Staff Member who referred, if applicable?

Education*

Name of School

Address

Years Completed

Did you graduate?

Degree Received

Areas of Specialization

NOTE: Verification of Education will be required of all prospective employees.

Have you ever been convicted of a crime or other criminal offense?*

Yes

No

Have you ever been arrested for a felony or do you have any felony charges pending?*

Yes

No

If you answered 'yes' to either question, please give dates, status, and explanation:

NOTE: A criminal History Check and Sex Offender Registry check will be completed for all prospective employees.

Licences

State

Registration Number

Dates

Type

Were you in the US Armed Forces?*

Yes

No

If yes:

Start Date

End Date

Branch

Type of Discharge

List memberships, activities, and other positions which you participate in, or have participated in, or other skills which you possess, which would further qualify you for a position at the Evansville Rescue Mission.

List Previous Employment, beginning with most recent.*

Name

Address

Telephone Number

Supervisor

Pay Rate

Start Date

End Date

Position Held

Reason for Leaving

May we check references?*

Yes

No

Give the names, addresses, andphone numbers of at least four persons who have known you for the past three years and can speak toward your personal character. Do not list supervisors listed previously or relatives.*

Name

Relationship

Address

Day Phone

Night Phone

List friends or relatives currently working for the Evansville Rescue Mission:

Please describe your personal philosophy as it relates to your interest in applying for the Evansville Rescue Mission. What led you to apply for a position? What do you hope to accomplish in this work? How does this fit with your career goal and interest?*

Applicant Certification and Agreement

I hereby certify that the statements made by me on this Application are true, complete, and correct to the best of my knowledge. I grant the Evansville Rescue Mission permission to verify such answers including a Criminal Record Check, Driving Record Check, Verification of Employment Eligibility, Health Status Verification, Education Verification, etc., and understand that any misstatements or omission of fact on this Application, or on related employment materials, may be considered as sufficient cause for rejection of this Application or for my dismissal if such information is discovered subsequent to my employment.
I authorize the Evansville Rescue Mission to make inquiry concerning my aptitude, skills, and character, including inquiry concerning my past employment records. I release the Evansville Rescue Mission, and al my previous employers and their respective agents and employees, from any and all claims arising in any way from their participation in such inquiry references check.
I understand that this Application will remain active for a period of six (6) months from the date of this Application and that I must notify the Evansville Rescue Mission in writing at the end of such period if I wish to reactivate or amend this Application, or if I wish to include any new / or changed information.
I further understand that if I am offered a position I will be asked to complete a Physical Examination and TB Skin Test, and may be requited to complete a Pre-Employment Drug Screening Test. I also accept that employment with the Evansville Rescue Mission shall be at wages, benefits, hours, conditions, and under other such employment policies as outlined in the Employee Manual of Policy and Procedure, which are subject to change at the agency's discretion. I understand that no one, other than the Executive Director of this agency, has any authority to enter into any agreement for a specified period of time or to make agreement which is contrary to the foregoing, and that any such agreement must be in writing and signed by the Executive Director in order for it to be binding.

I have read, understand, and agree to the Evansville Rescue Mission's Application Certification and Agreement*

Yes

Statement of Faith

This Statement of our faith should keep each of us grounded in biblical truth so that we can lead others to a saving knowledge of the Lord Jesus Christ and correctly disciple them.
The following declarations are statements of fundamental doctrines to which all who serve at the Evansville Rescue Mission should be in agreement with:
We believe in the Scripture of the Old and New Testaments as verbally inspired by God, and inerrant in the original writings, and that they are of supreme and final authority in faith and life.
We believe in one God, eternally existing in three persons: Father, Son, and Holy Spirit.
We believe that Jesus Christ was begotten by the Holy Spirit, and born of the Virgin Mary and is true God and true man.
We believe that man was created in the image of God; that he sinned, and thereby in¬curred, not only physical death, but also that spiritual death which is separation from God; and that all human beings are born with a sinful nature, and in the case of those who reach moral responsibility become sinners in thought, word and deed.
We believe that the Lord Jesus died for our sins according to the Scriptures, as a represen-tative and substitutionary sacrifice; and that all who believe in Him are justified on the grounds of His shed blood.
We believe in the resurrection of the crucified body of our Lord, in His ascension into heaven, in His present life there for us, as a High Priest and Advocate.
We believe in "that blessed hope", the personal and imminent return of our Lord and Savior, Jesus Christ.
We believe that all who receive by faith the Lord Jesus Christ are born again of the Holy Spirit and thereby become children of God.
We believe in the bodily resurrection of the just and unjust, the everlasting blessedness of the saved, and the everlasting, conscious punishment of the lost.

I have read, understand, and agree to the Evansville Rescue Mission's Statement of Faith*

Yes

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